外耳道后壁重建式乳突切除术和鼓室成形术的临床疗效观察

The clinical observation of curative effect from reconstructing posterior wall of auricular meatus for intact-wall mastoidectomy and tympanoplasty

目的初步探讨在部分乳突腔狭小而需行乳突切除术的慢性化脓性中耳乳突炎(主要为胆脂瘤型和骨疡型及两者兼有的混合型)患者,外耳道后壁重建式乳突切除术在既需彻底清除病灶、又应尽可能多地保留或改善听觉功能方面的临床价值和意义。方法对临床7例因中颅窝底低位和乙状窦壁前位而造成乳突腔狭小的胆脂瘤型和/或骨疡型中耳乳突炎患者,在行乳突切除术中采用外耳道后壁切除和重建技术,最终保持完整的鼓室和外耳道壁,再行I期或II期鼓室成形术重建鼓室传音结构,手术前后检查听觉功能,与同期进行的12例慢性化脓性中耳乳突炎而行经典的完壁式乳突切除术患者进行对照。结果外耳道后壁重建技术可有效地解决乳突腔狭小患者行完壁式乳突切除术中病灶清除困难、并发症发生率高、易致胆脂脂瘤等病变组织残留或复发等问题。本次观察的全部19例患者在行II期鼓室成形术或鼓室探查术中均未发现胆脂瘤复发,术后平均气导听阈较术前明显降低,传导性聋的改善程度两组之间无显著性差异,未发生明显的手术并发症。结论采用外耳道后壁重建技术的完壁式乳突切除术可基本达到与经典的完壁式乳突切除术等同的听觉功能保留与提高效果,故对于有相关适应证患者,应作为常规选择手术方式。I期或II期鼓室成形术对于提高中耳传音功能(即听力?

Objectives We primarily probed into the reconstructing posterior wall of auricular meatus for intact-wall mastoidectomy and tympanoplasty, and that might or might not outright eliminate pathological tissues and reserve or improve middle ear sound-transmitting function at the same time in patients with chronic suppurative otitis medium( including cholesteatoma and ostitis mastoidea or both coexistence), whose mastoid cavity is very small as a result of lower top-wall of mastoid cavity and farther front of sigmoid sinus bone-wall. Methods In 7 chronic suppurative otitis medium patients with small mastoid cavities, whose middle skull base was obviously lower and the bone-wall of sigmoid sinus was more front, the technique of reconstructing posterior bone-wall of auricular meatus was utilized for intact-wall-type mastoidectomy and tympanoplasty. Before and after surgery, the hearing function was measured with pure tone audiometry, and in comparison with 12 patients who suffered from same disorders and proceeded classical intact-wall-type mastoidectomy and tympanoplasty. Results The technique of reconstructing posterior bone-wall of auricular meatus was introduced in the intact-wall-type mastoidectomy and tympanoplasty proceeding for the chronic suppurative otitis medium patients with small mastoid cavities, which provided sufficient interspace and direct view for outright eliminating pathological tissues (including cholesteatoma and acestoma) more safely and conveniently. The elevated degrees of middle ear conducting-sound function had no evidently different between two groups following farther tympanoplasty. The leftover or recrudescent cholesteatoma and other any subsequent symptoms were not found in all patients. Conclusion The effects of reserving or improving conductive hearing function is equal on the whole between the reconstructing posterior bone-wall of auricular meatus and classical intact-wall-type mastoidectomy and tympanoplasty. So, if the patients show correlative indication symptoms, the reconstructing posterior bone-wall of auricular meatus for intact-wall-type mastoidectomy and tympanoplasty should be chosen routinely.